How I manage my mental health

Do you know that feeling, of drifting into wakefulness on a morning, the dream still half there, reality drawing into view, the sense of where you are in time and space slowly dawning, and then wham! Suddenly you realise that this is life, this is real life, and you can’t do anything to avoid it? For a little while there, in that dream, you had escaped it. But now you’re awake, and now you brace yourself for the onslaught that the day will bring.

That’s what it used to be like for me, every single day. The dread as I realised that I was waking up. The sense of tensing everything inside me to shield myself from what was coming. The knowledge that stuff would happen and I’d be at its mercy: flashbacks, feelings, triggers, pain, switching, terror, confusion, dread. The only thought with which I could console myself, lying there in bed on a morning, was that in roughly 16 hours’ time the day would be over. And maybe I could try to sleep again. (It was never much of a consolation, as the terror of nightmares and the incessant battle with insomnia brought its own struggles. But upon waking, I chose to forget this, holding out at least some hope for the end of the day.)

Life happened to me. And life, at that time, mainly consisted of bad things. I spent the entire day on the defensive. I was pummelled by one thing after another.

Does this sound familiar?

It’s a strange thing, that I wake up on a morning now and, no matter what crisis lies ahead, whatever challenges I know the day will bring, I wake feeling hopeful, not hopeless. I am largely in charge of life, rather than it controlling me, as it used to.

And it’s not because life has stopped throwing me curve balls. It’s simply because, over a period of time, I learned how to catch them. I learned how to put certain practices in place in my life that allow me to cope with the day without it overwhelming me. And most days – most! (I’m not perfect!) – it works.

These practices come in different shapes and sizes. Some are for ‘in the moment’, when big feelings hit or a crisis crash-lands in front of me: these are the things I do to avoid being overwhelmed, to be able to deal with what needs dealing with, and not be thrown off track. Some are daily habits and rituals, which provide emotional nutrition to give me the strength to cope with what comes. Some are weekly, some are monthly, termly or seasonal, and some are yearly. I firmly believe that it doesn’t always matter so much what we do, so much as that we do something. So here are a few ideas from what I do to spark some thoughts about what you can do.

1. In the moment strategies

A. I breathe

Feelings are inherently physical. We feel sick to our stomach or punched in the gut; we’re heartbroken or feel winded. Recognising that we experience emotions in our bodies, my first response to them is always to breathe. Emotions invariably cause our breathing to shallow and speed, so I counteract this. Not by breathing in – because this tenses me more, and it often feels, when upset, that there’s no space for the air to fill – but first of all by breathing out. Emptying my lungs, pushing the air out through my mouth like I’m blowing up a balloon. Emptying, and then emptying some more – it’s a strange phenomenon that when we feel our lungs are empty, there’s always more to come. I push the air out of myself.

And then I let get of the tension needed to do that. And automatically, without effort, the air comes rushing in: it’s simple physics. And then I do it again. And again. And so, when my body screams with the agony of emotion, when my heart is racing and nausea is gripping my guts, I breathe. Just for a few minutes. But I deliberately focus my attention on counteracting the reaction in my body, with this one, simple technique.

I’d known about it for years before I implemented it. It always sounded so stupid. ‘Breathe!’ people would say. ‘Just take a breath’, ‘deep breaths now!’. I always felt patronised, even insulted. They obviously didn’t understand just how upset I was.

I needed to understand some of the physiology of it, the way that breathing out, deep diaphragmatic breathing (from the depths of our belly), engages the vagus nerve which slows our heart rate and settles the flow of stress hormones into our bloodstream. Once I began to understand that it had some science behind it, I was less dismissive.

But, as with most things, when it wasn’t magic the first time I tried it, I was tempted not to bother again. I had to keep at it. I had to keep doing it, until it began to work. And then, over time, it became a ‘positive trigger’: something that I expect to help calm my body, and which now does. Today it’s my most powerful tool in the battle against overwhelm (and it’s free.)

B. Mantras

‘Mantras’ is a silly word, if I’m honest. But the English language doesn’t offer a better alternative. ‘Sayings’ sounds like the village soothsayer came up with them. ‘Reminders’ smacks of shopping lists. So although ‘mantras’ suggest some New Age-y element to them (which absolutely isn’t the case) I think it’ll have to do. That for me was the first hurdle: overcoming my distaste for the word. Cynicism disarmed, I set about figuring out if they might help.

Eventually I realised that ‘mantras’ are used by everybody. Paramedics, the military, teachers in schools. ‘ABC: Airways, Breathing, Circulation’ is one I learnt on a first aid course. ‘Ready, Aim, Fire’ makes obvious sense (please don’t fire before you’ve readied yourself and taken aim). ‘Sit up straight, fingers on lips’ was what I grew up with in a 1970s primary school as a way of establishing control of chattery 5-year-olds.

Why do we use them? They remind us of order. They set in motion a series of responses. They give us direction and clarity. We know what’s expected; we know what to do next.

So when big feelings hit, mantras can be really powerful. They have to be personal to you: they have to mean something. They have to trigger your brain with hope, a sense of relief, a feeling of control, a belief that things will get better. I have dozens of them: ‘This too shall pass’ is one I frequently say to myself. Big feeling hits: I breathe, and I say to myself, ‘This too shall pass.’ It reminds me of the temporary nature of the feelings, and the situation causing them. It reminds me to hold on, because it won’t last forever: not to fall into the trap of exacerbating the situation by believing that this is permanent and pervasive. This too shall pass.

‘You’re okay, I’m with you, we got this’ is another. It’s me talking to myself. It started off as a way of me talking to my parts. It was a way of taking charge, showing leadership, playing the role of the calming adult. The mental image in my head when I say it is of me staring down the challenge. Looking it in the eye, refusing to flinch, holding my ground. And calmly and steadily gathering myself – my ‘selves’ – around me and taking one step forwards, towards the danger, towards the feeling, towards the problem. ‘You’re okay, I’m with you, we got this.’ Be calm, be confident. Reassure yourself.

‘What’s the worst that can happen?’ I have to be able to say this with some humour. Sometimes it made things worse – a thousand catastrophes would present themselves unbidden to my mind. So it’s said with sardonic dryness. It’s the humour itself that is calming. It’s an attempt to step back from myself and the situation, and choose my reaction – humour rather than horror.

Over the years I’ve learned that the ‘worst thing’ is something that I’ve already experienced and survived. There is very little else in life that I cannot face, given what I went through as a child. So it’s a reminder to myself of that. And in reality, most challenges I face now are only as bad as being in a lift with a dozen wasps. The worst that can happen is that you get stung by all them, go into anaphylactic shock and die … no, no, I mean, the worst that can happen is that you get stung once or twice because you panic and start flapping at them. But the doors will soon open, and you’ll get out, and it might smart for a while, but you’ll survive. It won’t be the best day you’ve ever had, but it won’t be the worst.

So this is all about mentalising and reframing. Stepping back from being in the situation, applying a dry touch of humour, and trying to get some perspective. I usually try to laugh myself into realising the catastrophe I’m fearing, to realise how far-fetched and ridiculous it is. For me, it almost always works. In the words of Blackadder: ‘I laugh at danger and drop ice cubes down the vest of fear’. In the office, facing a crisis, we imagine looking back in years to come and reminiscing ironically: ‘Oh, how we laughed!’

2. Daily strategies

A. Sleep

This sounds a strange one for staying on track but I’ve only recently begun to appreciate its true effectiveness: I get up at exactly the same time each morning (very early) and I go to bed at roughly the same time each night (also very early), and I aim for 8 hours’ sleep.

We can’t cope with emotions when we’re tired. This is what all parents know of all children. Why do we think it stops affecting us once we’re old enough to vote? I absolutely have to have regular bedtimes and uptimes to stay on top of my emotions and be able to cope with life. It’s been a long journey, and a battle with insomnia, to get there, but it is now the bedrock of my life.

It took a lot of work. For years I relied on medication, rather than dealing with the root cause. I have also recently worked extensively on my environment, to improve things by 1% (marginal gains): blackout blinds (even blackout film on the windows) for a completely dark room; no blue light before bedtime; no caffeine after midday; no stimulating TV on an evening; a super-cool room; wave and sea-sounds playing through the night. I had to get extreme to get over my extreme insomnia. It’s, quite honestly, changed my life.

B. Mindfulness meditation

The third thing I do after waking up on a morning (yes, I’m anal enough to have a list and to stick to it!) is twenty minutes of mindfulness meditation. I do it now every morning without fail. I use the Headspace app (www.headspace.com) and I find it brilliant.

I’ve done mindfulness stuff for years, but since I’ve been doing it regularly, every single morning, I’ve found it most beneficial. I might also do another one later in the day if I really need to find some peace. But it works best when it becomes a daily habit, because then it’s building new neural networks. It’s changing our brains over time, to make us less reactive to emotions.

I wouldn’t miss my morning meditation now for the world: I absolutely love the deep sense of calm I have at the end of twenty minutes. Even if all hell is breaking loose around me, at least I’m starting from a good place. And it reminds me, daily, that I can get back there. So I just have to get through until my next session. It’s been life-saving.

C. Walks outdoors with my dog

There are untold benefits to being outside. When we allow our eyes to focus on vista, on the long-distance panorama around us of sky and open fields, our blood pressure drops. It’s unconscious but it works. We can’t sit and force ourselves to have lower blood pressure. But we can put ourselves in the kind of setting where it will naturally happen.

My daily or twice-daily walk with my dog is crucial to my mental health. Similar to sleep, it’s been a struggle to get to the point where I can do this every day, especially with a long history of chronic fatigue and pain. But, like breathing, it engages physiological mechanisms to help us manage emotions. It counteracts the flood of stress hormones – adrenaline, noradrenaline, cortisol – and discharges them.

Being in nature is incredibly important to me and if I haven’t seen sky and trees and birds and fields at least once every day, I start to feel a bit quivery. I need nature. It regulates me. And it took me years to realise this – I thought it was just something I liked, not something that would actually help. I kept waiting until I felt better until I made plans to go outdoors. Instead I began to realise that I need a daily habit of being outdoors regardless of what’s happening. And the more that’s kicking off for me, the more I need to fill myself with outdoorsiness. Waterproofs are my most essential clothing item: ain’t no rain gonna stop me now.

3. Weekly strategies

I work Monday to Friday and I often work on Saturdays too. So Sundays are my true sabbath. And it’s imperative for me, as an extreme introvert, to have at least some of the day to myself. I need solitude to recharge.

A recent habit that I’ve implemented is going swimming on a Sunday. The exercise is good, but not the main purpose. It’s just that it’s so different. It’s a break from everything else. And afterwards I sit in the lounge area attached to the pool and I journal. I review the week behind, and I plan the week ahead. I step back from the day-to-day and I zoom out to the wider perspective. I check in with myself. How am I feeling? What’s been going on for me? What’s the bigger picture? Invariably, it is soothing and reassuring and restorative to do this. I always gain perspective. I see where I’ve been heading down rabbit-holes. I see where I’ve been tempted to cut corners on my daily rituals. I see where I’ve not practiced sufficient self-care, or compassion for others, or had enough rest.

And so I perform a course correction. This way, I only ever go a week off track before pulling myself back in line. This, too, is a lifesaver. It also gives me a sense of completion – that week is over, and a new week is ahead. Whatever crap happened last week doesn’t spill over into this week. However exhausted I ended up feeling last week, tomorrow is a new day. I draw a line under it, and I go through a process of figuring out how I want the week ahead to pan out. Of course it will never end up being as I’ve planned. But the point is that I give myself a sense of control over it. I stifle any feelings of helplessness or powerlessness that have crept up on me over the previous seven days. I start again.

4. Monthly, termly or seasonal strategies

When I was in therapy, we always worked in roughly six-week segments. Sometimes it was slightly shorter, and sometimes slightly longer, but there was a general pattern. Six weeks was about the right period of time for us to be able to focus: what are we going to work on? What can we realistically try to achieve? What’s the main emphasis? Then six weeks, hammer and tongs, diving in deep, dealing with stuff, and knowing that a break was coming.

At first I hated the breaks. I felt dependent on the regulation of a therapy session to get me through. A two or three week break always felt like eternity. Eventually I stopped kicking against the goads and realised that affect regulation was my deal, and that I had to have more than one strategy for it. It wasn’t wise to have all my eggs in one basket and be dependent on something (the session) or someone (the therapist) to manage my emotions. So I began to use the breaks as an opportunity to put new strategies in place. Towards the end of therapy, I began to appreciate the breaks. However tough the sessions were, there were only six of them, and then I would have a break. It helped me to focus and direct my emotional energy accordingly.

Since ending therapy, I’ve implemented a similar system in my work. Like sleep and walking, it took a long time to deliver the strategy I needed to be able to have the rhythm in place that I wanted. It took a lot of planning and investment – I had to implement it; it didn’t just happen – but I now operate mainly on the basis of working at full intensity for six weeks or so, and then I have at least a week’s break away in the Highlands. Although I often work when I’m up there, it’s a different kind of work: it’s studying, writing, introverted stuff. It’s not giving out, training, meetings, people. So it’s restorative. And it’s become another essential for my self-care and wellbeing that works for me.

My time away on this schedule is like pressing a reset button. The drastic change of scenery, the contrast in the pace of life, the lack of good internet, the raw and wild weather, the people, the culture, the way of life … I go from a centrally-heated modern Lego house on a new build estate to an old crofter’s cottage with sheep roaming the garden. My morning ritual there includes emptying and restocking the log burner. I live in wellies and waterproofs (although, to be fair, sometimes I take them off indoors). I have a complete break from ‘normal’ life.

And it does something profound to me. Because I know that, however much life throws at me during my six weeks ‘down south’ (as everywhere is compared to the Highlands), I’ve got an escape coming up. It will end. I will get away. I can turn off my phone and social media if I need to (or rather, I am often forced to due to poor reception). I can breathe unpolluted air and plan my day around the tide times. It’s a completely different way of being. It’s thoroughly restorative.

There is no way I could cope with the pace and intensity of my work if I didn’t have this as an escape. The journey up and back – a minimum usually of ten hours by car – is itself a form of decompression. I ‘think out’ all the stress that’s been harrying me for six weeks. I let my anxiety drift out with the exhaust fumes. As the scenery changes and I go from the flatlands of Cambridgeshire to the hills of the Lake District to the mountains of Scotland, it’s almost as if I change lives.

I’ve known for many years that I need this kind of an escape if I’m to sustain the work I do, and it took many years to bring it into reality. It’s the single biggest thing I do for my mental health.

5. Yearly strategies

Once a year, often around Christmas or New Year, I take a day or two minimum and I review my year. I go back over my journals. I see the progress I’ve made. I identify recurrent holes in the road. And then I plan the year ahead: What are my goals? What will my main focus be? What do I want to be saying and thinking and feeling when I do this review again in 12 months’ time? What are the three areas that I’m going to focus on over the year ahead?

I do long-range planning and it doesn’t matter if what I think is relevant in December doesn’t seem as relevant 12 months later. I can change course if I need to. But I don’t start the year without an itinerary. I figure out what I’ll need and I peer into the future and try to imagine what harvests I will need, and when and where I’ll need to sow to achieve that.

I learned this on a leadership course over twenty years ago. But I never saw it as relevant to me until recently. Because I used to see myself as simply ‘mad’. Messed up. Broken down. Someone with mental health issues. I thought it was only competent people who did things like yearly reviews. Seemed all a bit serious.

And then eventually I realised that if you want to be the competent person, you need to do what competent people do. You only start living their life if you do the things they do, even before you’re ready.

I felt silly the first time I did an annual review – full of self-importance, and embarrassed at how inadequate I was to the task. After all, I found it difficult to plan my Tesco delivery for the week ahead, let alone plan a year ahead. But I started doing it, and it made a difference.

Every time now I go to Scotland, I spend at least a few hours reviewing my progress on my yearly plan. Mostly what I’ve done to date doesn’t tally in the slightest with what I’d planned to do. But that’s okay, as long as there are good reasons for it. It helps me identify if I’ve been blown off course or whether I intentionally adjusted the rudder. And that helps a lot, to plan the next course correction.

We often think of managing emotions only in terms of what we can do in the moments when feelings erupt. My process over the last few years has been to realise how much our overall habits play a part. I’ve realised that I cannot just fight fires: I need to build with flame-proof materials. It’s hard work, to be so intentional about your life. But what I’ve also learned is that it’s a lot less hard work than dealing with constant crises. Managing my mental health before it deteriorates takes a lot less effort than coming back from the brink. It’s an investment that reaps a hundredfold.

What can you do, today, to start building a life that supports your mental health?

A word of explanation

I had therapy mainly between 2006 and 2015. These blog posts are not verbatim accounts of sessions, but rather the client equivalent of ‘case studies’ - amalgamations of various sessions, ‘narratively true’ rather than ‘historically true’. Although often written for stylistic purposes in the present tense, they are very much from a past period of my life. Ideally they should be read within the wider context of other blog posts, articles and my book, to give a more integrated and rounded sense of where I was at, where I’m at now, and the process that took place between those two points. I have been on a journey of recovery, and the difference in me from when I was in therapy (especially at the beginning) to now is testament to the brain’s ability to recover from even the most appalling suffering.

My primary work now is writing, followed closely by training therapists, counsellors and other professionals to support survivors of trauma. Regrettably I cannot provide one-to-one support but our charity framework PODS (Positive Outcomes for Dissociative Survivors) provides a helpline and a range of other services: please go to www.pods-online.org.uk for more information, and https://support.pods-online.org.uk/start-here if you are looking for support.

12 Comments

But how do you/ did you manage nightmares/night terrors? They are ruining my life and physical and mental health……I am doing all the right ‘ sleep hygiene’ things…..( sorry if I shouldnt ask this…no need to answer….anyone else got any tips/advice?)

Hello Me, I thought I would write a note here because you seem apologetic for asking when its completely ok. I too struggle in the nights, and early mornings, oof, forgedabowdit! I have 2 mantras that bring me comfort: “something good will come of this” and “this too shall pass” . they are very calming for me.
i go to bed with my little girl at 8pm and wake up around 6am, this definitely helps. I don’t listen to news or read papers. I do mindfulness meditation. I sew.
I hope you can find positive strategies. I think you will, you are ok. you will be ok, we all will. xx

Hi Carolyn. Thank you so much for writing and sharing this inspirational, practical, hopeful, calming piece. I think it’s a brilliant idea too to expand your great energy, knowledge and experience to a wider audience… all is so relevant to struggles with affect regulation and legacies of trauma whatever shape they may take.
Thank you

That’s not a stupid question at all! 🙂
What I use is called ‘Binaural Beats – 5 hours of calming and soothing ocean wave sounds’ and it’s on Amazon Music. I then just set it to play on repeat. Lots of other options and also on things like Spotify.

Self-care is entirely counter-intuitive to survivors of abuse. To me as an abused child it is obvious that I am bad. I am being hurt because I am bad. And I am bad because I hurt. It’s a never-ending cycle of self-evident obviousness.